Influence of Hearing Rehabilitation With Active Middle Ear and Bone Conduction Implants on Postural Control.

Background: As audition also seems to contribute to balance control, additionally to visual, proprioceptive, and vestibular information, we hypothesize that hearing rehabilitation with active middle ear and bone conduction implants can influence postural control. Methods: In a prospective explorative study, the impact of hearing rehabilitation with active middle ear [Vibrant Soundbrige (VSB), MED-EL, Innsbruck, Austria] and bone conduction implants [Bonebridge (BB), MED-EL, Innsbruck, Austria] on postural control in adults was examined in three experiments. Vestibulospinal control was measured by cranio-corpography (CCG), trunk sway velocity (°/s) by the Standard Balance Deficit Test (SBDT), and postural stability with a force plate system, each time in best aided (BA) and unaided (UA) condition with frontal-noise presentation (Fastl noise, 65 dB SPL), followed by subjective evaluation, respectively. Results: In 26 subjects [age 55.0 ± 12.8 years; unilateral VSB/BB: n = 15; bilateral VSB/BB: n = 3, bimodal (VSB/BB + hearing aid): n = 8], CCG-analysis showed no difference between BA and UA conditions for the means of distance, angle of displacement, and angle of rotation, respectively. Trunk sway measurements revealed a relevant increase of sway in standing on foam (p = 0.01, r = 0.51) and a relevant sway reduction in walking (p = 0.026, r = 0.44, roll plane) in BA condition. Selective postural subsystem analysis revealed a relevant increase of the vestibular component in BA condition (p = 0.017, r = 0.47). As measured with the Interactive Balance System (IBS), 42% of the subjects improved stability (ST) in BA condition, 31% showed no difference, and 27% deteriorated, while no difference was seen in comparison of means. Subjectively, 4-7% of participants felt that noise improved their balance, 73-85% felt no difference, and 7-23% reported deterioration by noise. Furthermore, 46-50% reported a better task performance in BA condition; 35-46% felt no difference and 4-15% found the UA situation more helpful. Conclusions: Subjectively, approximately half of the participants reported a benefit in task performance in BA condition. Objectively, this could only be shown in one mobile SBDT-task. Subsystem analysis of trunk sway provided insights in multisensory reweighting mechanisms.

Enhanced sprint performance analysis in soccer: New insights from a GPS-based tracking system.

The aim of this investigation was to establish the validity of a GPS-based tracking system (Polar Team Pro System, PTPS) for estimating sprint performance and to evaluate additional diagnostic indices derived from the temporal course of the movement velocity. Thirty-four male soccer players (20 ± 4 years) performed a 20 m sprint test measured by timing gates (TG), and while wearing the PTPS. To evaluate the relevance of additional velocity-based parameters to discriminate between faster and slower athletes, the median-split method was applied to the 20-m times. Practical relevance was estimated using standardized mean differences (d) between the subgroups. Differences between the criterion reference (TG) and PTPS for the 10 and 20 m splits did not vary from zero (dt10: -0.01 ± 0.07 s, P = 0.7, d < -0.1; dt20: -0.01 ± 0.08 s, P = 0.4, d < -0.2). Although subgroups revealed large differences in their sprint times (d = -2.5), the average accelerations between 5 and 20 km/h as well as 20 and 25 km/h showed merely small effects (d < 0.5). Consequently, analyses of velocity curves derived from PTPS may help to clarify the occurrence of performance in outdoor sports. Thus, training consequences can be drawn which contribute to the differentiation and individualization of sprint training.

Does low back pain affect the reliability of postural regulation?

The aim of this study was to examine the intraobserver reliability of a posturographic assessment in patients with low back pain. We investigated 24 symptomatic subjects with defined low back pain (mean: 57.9 years) and a pair-matched control group including 24 asymptomatic persons (mean: 58.1 years). Each participant underwent two measurements on a posturographic device (32 Hz sampling rate) based on the Interactive Balance System (time interval: 7 d). Test procedure consisted of tests on solid ground with eyes open (1) and eyes closed (2). Data analysis included parameters of motor output and a frequency band analysis. Reliability tests were realized using by intraclass correlations (ICC). Coefficients of ICC ranged from 0.36 (95% CI: 0.01-0.73) to 0.94 (95% CI: 0.86-0.97) in both test positions. For 69% (11/16) of the investigated parameters a high level (ICC > 0.75) of intraobserver reliability was reached. Based on the results, the posturographic measurement system used in this study seems to be appropriate for use in longitudinal study designs in an orthopaedic setting.

Comparison of posturographic outcomes between two different devices.

The Interactive Balance System (IBS), a posturography device for assessing posture control, is widely used in clinical and rehabilitation settings. However, data on the validity of the device are unavailable. Fluctuations of the center of pressure (COP) were measured in 24 healthy participants (age: 29 ±â€¯5 (mean ±â€¯SD) years, 12 females) synchronously using the IBS, which was rigidly mounted on a Kistler platform. Four different bipedal conditions were examined: eyes open or closed on stable or soft surfaces. Time series were compared using congruity (CON, proportion of the measurement time during which values of both devices changed similarly in direction), whereas IBS-specific postural outcomes were correlated with traditional postural control outcomes of the Kistler force platform. The time-displacement curves showed similar shapes for CON (>0.9) for each of the four standing conditions without differences between male and female participants (P > 0.39). The path length results of both devices showed very high linear associations, explaining on average 92% (medio-lateral) or 96% (anterior-posterior) of the common variance. The Kistler path length of the anterior-posterior direction revealed nearly perfect linear associations with the stability index of the IBS (r2 > 0.99). The results of this study indicate that the IBS provides valid posturographic results. Since the medial-lateral and anterior-posterior trajectories of the IBS can be used to calculate COP fluctuations, comparisons between different measurement systems are possible.

Reliability of an ice hockey-specific complex test.

BACKGROUND: This study assessed the intra-rater reliability of an ice hockey-specific complex test (IHCT) that reflects the intense multidirectional and intermittent efforts required in ice hockey. METHODS: Twenty professional players executed the IHCT twice over an interval of 2 days. Load parameters included a 10-m sprint, a 30-m transition with and without a puck, as well as slap and wrist shots. Stress parameters were lactate concentrations and heart rates. RESULTS: The intrarater reliability (ICC) ranged from 0.54 to 0.98 for load parameters, and from 0.26 to 0.87 for stress parameters. 33 % (3/9) of stress parameters and 82 % (18/22) of load parameters had an ICC > 0.75. The largest limits of agreement were 41.6 for slap shot 1 after test and 50.4 for 6-min heart rate recovery. The smallest were 0.40 (10-m sprint without a puck) and 5.36 (resting lactate). The intra-rater reliability as shown by the coefficient of variation (CV) was lower for stress than for load parameters (mean CV: 13.4 vs. 4.7). 68 % (15/22) of load parameters and 11 % (1/9) of stress parameters showed a CV below 5 %. CONCLUSION: The IHCT is currently the only ice hockey-specific complex test with scientifically tested reliability and validity that can analyze performance under conditions similar to competition. It is suggested that coaches, fitness coaches and sports scientists explore use of this test as a valid tool to assess players' performance and the effectiveness of training interventions.

Validity of a basketball-specific complex test in female professional players.

The purpose of this study was to assess the validity of a new basketball-specific complex test (BBCT) based on the ascertained match performance.Fourteen female professional basketball players (ages: 23.4 ±â€Š1.8 years) performed the BBCT and a treadmill test (TT) at the beginning of pre-season training. Lactate, heart rate (HR), time, shooting precision and number of errors were measured during the four test sequences of the BBCT (short distance sprinting with direction changes, with and without a ball; fast break; lay-up parcours; sprint endurance test). In addition, lactate threshold (LT) and HR were assessed at selected times throughout the TT and the BBCT and over 6 (TT) or 10 (BBCT) minutes after the tests. The match performance score (mps) was calculated on specific parameters (e. g. points) collected during all matches during the subsequent season (22 matches). The mps served as the "gold standard" within the validation process for the BBCT and the TT.TT parameters demonstrated an explained variance (EV) between 0 % (HR recovery) and 11 % (running speed at 6 mmol/l LT). The EV from the BBCT was higher and ranged from 0 % (HR recovery 6 minutes after end of exercise) to 28 % (sprint endurance test after 8 of 10 sprints). Ten out of 21 BBCT parameters (48 %) and 2 out of 5 TT parameters (40 %) demonstrated an EV higher than 10 %. Average EV for all parameters was 12 % (BBCT) and 6 % (TT), respectively. The BBCT had a higher validity than the TT for predicting match performance. These findings suggest that coaches and scientists should consider using the BBCT testing protocol to estimate the match performance abilities of elite female players.

Effect of an Age Simulation Suit on Younger Adults' Gait Performance Compared to Older Adults' Normal Gait.

Age simulation suits are used to demonstrate typical physical impairments of older age (e.g., strength and sensory losses) in younger individuals. The purpose of the current study was to describe gait performance in different age groups while wearing an age simulation suit. A total of 178 participants ages 18 to 85 (mean age = 50.4 years, SD = 16.4 years) were assigned according to their age decade to four groups with (ages 18 to 59) and two groups without (ages 60 to 85) the aging suit. Gait performance was measured with a gait analysis system (GAITRite®) while walking at a self-chosen pace. Velocity, step length, step time, and base width were measured. Comparable performance was found for step length and velocity between ages 40 and 49/50 and 59 and ages 60 and 69/70 and 85 (p < 0.05). Results showed no corresponding relationship between step time and base width for all age groups. Simulation training helps younger individuals better understand older adults' perspectives, allowing for more positive interactions. [Res Gerontol Nurs. 2017; 10(5):227-233.].

Walking a mile in another's shoes: The impact of wearing an Age Suit.

The "Age Suit" described in this article was developed to enable future designers, business leaders, and engineers to experience navigating the world as many older adults must. Tools such as this Age Suit offer the opportunity to "walk a mile" in another's shoes to develop empathy that can result in better design of spaces, goods, and services to meet the needs of a rapidly growing older population. This work first examined, through a series of clinical tests, whether younger adults' physical capacities were reduced in a direction consistent with aging by wearing a suit developed by the MIT AgeLab. An experiential learning task was then completed with the suit to understand its impact on completion of an instrumental activity of daily living. Results showed that younger adults wearing the suit experienced changes in task performance consistent with expected changes associated with aging. Participants' self-reports from the experiential learning task indicated that they were able to empathize with older adults regarding some issues they face while completing a grocery shopping task. Future research with the suit should involve a wider range of individuals from the population and examine what effect participants' levels of fitness have on the experience of wearing the suit.

Influence of combined physical and cognitive training on cognition: a systematic review.

BACKGROUND: Numerous daily activities require simultaneous application of motor and cognitive skills (dual-tasking). The execution of such tasks is especially difficult for the elderly and for people with (neuro-) degenerative disorders. Training of physical and cognitive abilities helps prevent or slow down the age-related decline of cognition. The aim of this review is to summarise and assess the role of combined physical-and-cognitive-training characteristics in improving cognitive performance and to propose an effective training scheme within the frame of a suitable experimental design. METHODS: A systematic electronic literature search was conducted in selected databases. The following criteria were compulsory for inclusion in the study: 1. A (Randomized) Controlled Trial (RCT or CT) design; 2. Implementation of combined physical and cognitive training, either simultaneously (dual task) or subsequently - at least one hour per weekly over four weeks or more; 3. Cognitive outcomes as a study's endpoint. RESULTS: Twenty articles met the inclusion criteria. It appears that either simultaneous or subsequently combined physical and cognitive training is more successful compared to single physical or single cognitive exercise. Training characteristics like length, frequency, duration, intensity and level of task difficulty seem to determine cognitive performance. However, the articles show that cognitive improvement seems to remain somewhat confined to trained cognitive functions rather than generalising to other cognitive or daily-living skills. CONCLUSION: Due to methodological heterogeneity among studies, results need to be treated with caution. We critically discuss the role of training characteristics and propose a potentially effective training intervention within an appropriate experimental design.

Intraobserver reliability of posturography in patients with vestibular neuritis.

The aim of the study was to establish the intraobserver reliability of a posturographic method in patients (n = 34) with vestibular neuritis. Intraclass correlation coefficients (relative reliability) for all parameters and test positions (ALL(mean)) ranged from 0.71 (95% CI: 0.41-0.85) to 0.92 (95% CI: 0.84-0.96). Absolute reliability (coefficient of variation) ranged between 3.1% (95% CI: 2.60-8.67) and 42.3% (95% CI: 40.7-74.5). Reliability of single test positions is much lower. The posturographic system showed good relative and satisfactory absolute intraobserver reliability for ALL(mean).

Can falls be predicted with gait analytical and posturographic measurement systems? A prospective follow-up study in a nursing home population.

OBJECTIVE: To validate previously proposed findings and to develop an objective, feasible and efficient bifactorial (risk factors: gait impairment and balance disorders) fall risk assessment. DESIGN: Prospective follow-up study Setting: Nursing homes (Halle/Saale, Germany). SUBJECTS: One hundred and forty-six nursing home residents (aged 62-101 years) were recruited. METHODS: Gait data were collected using a mobile inertial sensor-based system (RehaWatch). Postural regulation data were measured with the Interactive Balance System. Falls were recorded in standardized protocols over a follow-up period of 12 months. MAIN MEASURES: Gait parameters (e.g. spatial-temporal parameters), posturographic parameters (e.g. postural subsystems), number of falls. RESULTS: Seventeen (12%) of the participants had more than two falls per year. The predictive validity of the previously selected posturographic parameters was inadequate (sensitivity: 47%). The new measurement tool defined 67 participants showing an increased risk of falls. In reality, only 8 participants actually fell more than twice during the follow-up period (positive predictive value (PPV): 12%). The negative predictive value (NPV) was 88%. The posturographic frequency range F2-4 (peripheral-vestibular system), stride time and standard deviation of landing phase were the most powerful parameters for fall prediction. Gait and postural variability were larger in the high-risk group (e.g. gait speed; confidence interval (CI)(high): 0.57-0.79 vs. CI(low): 0.72-0.81 m/s). CONCLUSION: RehaWatch and the Interactive Balance System are able to measure two of the most important fall risk factors, but their current predictive ability is not satisfactory yet. The correlation with physiological mechanisms is only shown by the Interactive Balance System.

Definitions and methods of measuring and reporting on injurious falls in randomised controlled fall prevention trials: a systematic review.

BACKGROUND: The standardisation of the assessment methodology and case definition represents a major precondition for the comparison of study results and the conduction of meta-analyses. International guidelines provide recommendations for the standardisation of falls methodology; however, injurious falls have not been targeted. The aim of the present article was to review systematically the range of case definitions and methods used to measure and report on injurious falls in randomised controlled trials (RCTs) on fall prevention. METHODS: An electronic literature search of selected comprehensive databases was performed to identify injurious falls definitions in published trials. Inclusion criteria were: RCTs on falls prevention published in English, study population ≥ 65 years, definition of injurious falls as a study endpoint by using the terms "injuries" and "falls". RESULTS: The search yielded 2089 articles, 2048 were excluded according to defined inclusion criteria. Forty-one articles were included. The systematic analysis of the methodology applied in RCTs disclosed substantial variations in the definition and methods used to measure and document injurious falls. The limited standardisation hampered comparability of study results. Our results also highlight that studies which used a similar, standardised definition of injurious falls showed comparable outcomes. CONCLUSIONS: No standard for defining, measuring, and documenting injurious falls could be identified among published RCTs. A standardised injurious falls definition enhances the comparability of study results as demonstrated by a subgroup of RCTs used a similar definition. Recommendations for standardising the methodology are given in the present review.

[A novel posturographic method to differentiate sway patterns of patients with Parkinson's disease from patients with cerebellar ataxia]. / Neue posturographische Methode zur Differentialdiagnostik von Patienten mit Morbus Parkinson und Kleinhirnstörungen.

Nigrostriatal and cerebellar systems are important postural subsystems in neurologic rehabilitation. In this study, we investigated the ability to differentiate both systems via posturography and spectral analysis. This cross-sectional study included 156 study subjects with 52 individuals in each group (healthy controls, Parkinson's disease and cerebellar disease patients). The mean age of all groups was 61.3+/-13.4 years. We used the interactive balance system (IBS) to differentiate vertical pressure fluctuations on four independent force plates, each supporting one heel or the toes of each leg in eight test positions. We also performed a frequency analysis of the force/time signal. The univariate, multifactor covariance analysis was used for statistical evaluation. Variance analysis of the Parkinson's group (mean/95% CI: 23.0/20.5-25.5) and control group (mean/95% CI: 16.7/14.2-19.2) revealed the greatest differences in frequency range F1. Subjects with cerebellar disease showed significant differences compared with controls in all frequency ranges. Furthermore, cerebellar disease subjects showed a consistently lower postural stability compared with the Parkinson's (p<0.001) and control groups (p<0.001). Results from the present study suggest that the cerebellar and nigrostriatal system can be effectively differentiated and assessed with frequency-analyzed posturographic parameters. Furthermore, the IBS allows a highly practical differential assessment in neurologic rehabilitation.

Influence of pathologic and simulated visual dysfunctions on the postural system.

Visual control has an influence on postural stability. Whilst vestibular, somatosensoric and cerebellar changes have already been frequency analytically parameterized with posturography, sufficient data regarding the visual system are still missing. The aim of this study was to evaluate the influence of pathologic and simulated visual dysfunctions on the postural system by calculating the frequency analytic representation of the visual system throughout the frequency range F1 (0.03-0.1 Hz) of Fourier analysis. The study was divided into two parts. In the first part, visually handicapped subjects and subjects with normal vision were investigated with posturography regarding postural stability (stability effect, Fourier spectrum of postural sway, etc.) with open and closed eyes. The visually impaired and the normal group differed significantly in the frequency range F1 (p = 0.002). Significant differences of the postural stability between both groups were found only in the test position with open eyes (NO). The healthy group showed a significant loss of stability, whereas the impaired group showed an increased stability due to sufficient somatosensoric processes. Visually handicapped persons can compensate the visual information deficit through improved peripheral-vestibular and somatosensoric perception and cerebellar processing. In the second part, subjects with normal vision were examined under simulated visual conditions, e.g., hyperopia (3.0 D), reduced visual acuity (VA = 20/200), yoke prisms (4 cm/m) and pursuits (pendulum). Changes in postural parameters due to simulations have been compared to a standard situation (open eyes [NO], fixation distance 3 m). Visual simulations showed influence on frequency range F1. Compared to the standard situation, significant differences have been found in reduced visual acuity, pursuits and yoke prisms. A loss of stability was measured for simulated hyperopia, pendulum and yoke prisms base down. Stability regulation can be understood as a multi-sensoric process by the visual, vestibular, somatosensoric and cerebellar system. Reduced influence of a single subsystem is compensated by the other subsystems. Obviously the main part of reduced visual input is compensated by the vestibular system. Moreover, the body sway, represented by the stability indicator, increased in this situation.